Title:A Three-year Retrospective Study Looking at Preventing Hospital Acquired
Thrombosis
Volume: 22
Issue: 2
Author(s): Vipin Kammath, Anuj Gupta, Alexander Bald, Gavin Hope, Nisheeth Kansal, Ahmad Al Samaraee and Vish Bhattacharya*
Affiliation:
- Department of Surgery, Queen Elizabeth Hospital NHS Foundation Trust, Gateshead, UK
Keywords:
Deep venous thrombosis, DVY, thromboembolisthromboembolism, pulmonary embolism, venous, DVT prophylaxis.
Abstract:
Background: Hospital-acquired venous thromboembolism (HA-VTE) is defined as
cases of venous thromboembolism (VTE) that occur in a hospital and within ninety days of a
hospital admission. Deep vein thromboses (DVTs) most commonly occur within the deep veins
of the pelvis and legs. If the thrombus dislodges and travels to the lungs, it can result in a pulmonary
embolus (PE). VTE is associated with significant morbidity and mortality, accounting for
almost 10% of all hospital deaths. If risk factors are correctly identified and VTE prophylaxis is
prescribed, VTE can be a preventable condition. In 2010, NHS England launched The National
Venous Thromboembolism Prevention Programme. This included NICE guidance, and a VTE
risk assessment tool, which must be completed for at least 95% of patients on admission. The
National Thrombosis Survey, published by Thrombosis UK, studied how this program was implemented
locally, and audited HA-VTE prevention strategies nationally.
Objectives: Using the Thrombosis Survey and NICE guidance as an aide, this study collects data about
hospital-acquired DVT (HA-DVT) at the Queen Elizabeth Hospital in Gateshead (QEH) and aims to:
1. Identify cases of HA-DVT and understand the clinical circumstances surrounding these cases
2. Assess the quality of VTE preventative measures at QEH
3. Outline potential improvement in reducing the incidence of HA-VTE at this hospital
Methods: This retrospective cohort study used electronic records to identify all cases of DVT
between April 2019 and April 2022 at QEH. Cases of HA-DVT were defined as: a positive ultrasound
doppler report and either the case occurring in the 90 days following an inpatient stay, or
beyond two days into an admission. For these cases of HA-DVT, we recorded the: reason for
admission; admitting specialty; presence of an underlying active cancer and deaths occurring
within 90 days of diagnosis. We assessed the quality of VTE preventative measures, by recording
the: completion of VTE risk assessments; prescription of weight-adjusted pharmacological
VTE prophylaxis and provision of VTE prophylaxis on discharge. For HA-DVT cases occurring
within 90 days of an inpatient stay, the preventative measures were assessed on the original admission.
Electronic records were used to record the completion rate of the National VTE risk
assessment tool for all inpatients during this time frame.
Results: The VTE risk assessment tool was completed for 98.5% of all admissions. One hundred
and thirty-five cases of HA-DVT were identified between April 2019 and April 2022. Sixteen
patients with HA-DVT did not have VTE prophylaxis prescribed on admission. Eleven of these
patients had a clearly documented reason why anticoagulation was avoided. In HA-DVT cases
where pharmacological VTE prophylaxis was prescribed, 23% were prescribed an inappropriate
dose for their weight. If anticoagulation was required on discharge, this was prescribed appropriately
in 94% of cases. About 31% of the patients with HA-DVT had an underlying active malignancy.
Thirty-nine patients died within 90 days of the DVT being diagnosed; in only 1 case was
VTE thought to be a contributing factor to death.
Conclusion: The hospital exceeded the national standard of VTE risk assessment completion on
admission (greater than 95%). For almost a quarter of patients with HA-DVT, the dose of
thromboprophylaxis prescribed was not appropriate for weight. In five cases of HA-DVT,
thromboprophylaxis was omitted with no clear justification. HA-DVT often affects the most
clinically vulnerable patients and is associated with a high mortality.
